Jul 1, 2010 (CIDRAP News) – Two private risk-communication consultants who have done work for the World Health Organization (WHO) have published an analysis arguing that the agency's messaging missteps have lent undeserved credibility to accusations that it exaggerated the H1N1 pandemic threat in order to enrich pharmaceutical companies.

In a lengthy article published online this week, Peter Sandman and Jody Lanard write that the charges leveled at the WHO are "absurd." But they assert that the agency rendered itself vulnerable by making three communication errors in dealing with the pandemic: failing to acknowledge that the pandemic has been "mild overall," failing to acknowledge that the WHO changed some flu pandemic definitions and descriptions as the virus was emerging, and not acknowledging until June (2010) that its disclosures about conflicts of interest were inadequate.

The analysis, titled "The 'Fake Pandemic' Charge Goes Mainstream and WHO's Credibility Nosedives," was posted on Sandman's risk communication Web site, which is named after his formula for perceived risk: "Risk = Hazard + Outrage."

Sandman and Lanard wrote their article in the wake of the recent report by the Council of Europe (COE) and an investigative report in BMJ (formerly the British Medical Journal). The COE report gave formal voice to the charge that the WHO hyped the pandemic partly in order to enrich the companies that make vaccines and antivirals. The BMJ article focused on conflicts of interest, charging that the WHO's science advisors often have pharmaceutical industry ties that are not disclosed to the public.

In response to those reports, WHO Director-General Margaret Chan has strongly denied exaggerating the pandemic threat and denied any drug-industry influence on the WHO's pandemic response. But she and other WHO officials have acknowledged that the policies on disclosing potential conflicts of interest need improvement and have promised to strengthen them.

Also, the WHO has commissioned a committee of independent experts to review the WHO's handling of the pandemic. That group is meeting this week in Geneva, but its final report is not expected until next year.

In their own detailed declaration of interests, Sandman and Lanard report in their article that they both have done extensive consulting work, some paid and some unpaid, for the WHO on flu and other issues. That included a 3-month, paid stint by Lanard as the WHO's senior advisor on pandemic flu risk communication in 2005. Sandman is also affiliated with the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News, serving as unpaid deputy editor of the CIDRAP Business Source.

The two consultants sum up their argument thus: "The absurd charge that the World Health Organization (WHO) hyped a fake pandemic in order to enrich Big Pharma has gained undeserved mainstream credibility mostly because WHO has badly mishandled its risk communication about three issues: (a) the mildness of the pandemic (so far); (b) the debatable meaning of the term “influenza pandemic”; and (c) the inevitable—but not culpable—structural conflicts of interest of WHO advisors."

The most important mistake, according to Sandman and Lanard, is the WHO's refusal to acknowledge that the pandemic has been mild and that H1N1 flu activity, though not gone, is now quite low. They define "mild" to mean similar to some previous flu pandemics that the WHO has described as mild or relatively mild.

"By contrast, WHO has insisted on calling this pandemic 'moderate' instead," they write. "And its tone has often left people feeling as if it were claiming 'severe.'" They say there is a "huge gap" between the WHO message and the public's perception of the pandemic, leading to widespread skepticism about the agency's credibility.

(Some other experts have argued that the pandemic was not mild when judged by the death toll among young adults and children. In a study published in March in PLoS Currents: Influenza, a team of epidemiologists concluded that, when measured by the overall estimated years of life lost, the pandemic was at least as bad as a tough seasonal flu epidemic and possibly worse than the pandemic of 1968-69.)

Sandman and Lanard further suggest that the WHO's credibility gap was only exacerbated by the decision on Jun 3 to maintain the phase 6 pandemic alert. They say the pandemic data noted by the WHO at the time seemed to match the agency's definition of the "post peak" phase.

The WHO's second communication misstep was not acknowledging that it had changed some pandemic flu definitions and descriptions "just as H1N1 was emerging," according to Sandman and Lanard.

Other WHO critics have charged that the WHO purged severity from its definition of a pandemic specifically so that it could call the H1N1 epidemic a pandemic, pointing to earlier documents that mentioned "enormous numbers of deaths and illness." WHO officials said that language reflected concerns about the threat from the H5N1 avian flu virus and was never part of a formal definition, and also that it was deleted in revised guidance completed in February 2009, 2 months before the H1N1 virus emerged.

Sandman and Lanard write, "When WHO changed some of its definitions and descriptions of flu pandemic phases in ways that de-emphasized severity, it opened the door to suspicion that it had 'changed the definition of a pandemic' in order to make sure H1N1 would qualify."

The third WHO mistake, according to the two consultants, was not acknowledging until last month "that WHO transparency about conflicts of interest had become inadequate."

Previously, the agency responded to conflict-of-interest allegations by simply explaining its policies and insisting that they work, the article says. Only after the attacks from the COE and BMJ did the WHO concede that it may need to be "both tougher and more transparent about its expert advisors' conflicts of interest."

Sandman and Lanard qualify their argument by saying that WHO officials "have periodically made statements that can be read as acknowledging all the points we're accusing them of failing to acknowledge." But they say the main thrust of the WHO's messages continues to be that H1N1 is a pandemic of moderate intensity, that the definition of a pandemic has not changed, and that WHO deliberations have been "self-evidently free of dangerous conflicts of interest."